Evidence Based Criteria for the Antidepressant Choice

Antidepressant drugs are, according to some estimates, the most widely prescribed class of drugs in the population with 253.6 million prescriptions in 2010 in the United States of America (1). This capacity is due to a number of factors including a wide range of indications and an overall good tolerability. Therefore antidepressants are currently prescribed very frequently by physicians, also recommended by non psychiatrists. The success of antidepressants led to the development of many new compounds over the last decades and we are now able to use more than 40 licensed compounds licensed in the treatment of depression. The availability of so many compounds is positive on one hand, because of the possibility to choose within a wide range of different compounds; but on the other hand it causes confusion for the clinician, who may not be aware of the differences across so many apparently similar drugs. As a result, in the clinical practice many psychiatrists usually prescribe only a small number of compounds which they are familiar with and never or seldom take into consideration other compounds. It is not exceptional to encounter colleagues who prescribe just 2 or 3 different antidepressants, therefore neglecting a wide range of other compounds which could be better suited for their patients. Therefore, the big challenge, which is the main aim of this editorial, is to solicit the awareness within psychiatrist of the whole range of therapeutic possibilities that we have. In fact, on the contrary to what is currently believed, antidepressants are very different one from another and the selection should be performed with great care taking into consideration a wide range of evidence based factors.